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Updates in Low Back Pain and Female Pelvic Floor Dysfunction, Review Article

Doaa A. Abdel Hady

Department of Physical Therapy for Women's Health, Deraya University, Egypt

E-mail : aa

DOI:10.15761/PRR.1000135

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Abstract

The mechanical properties of the female pelvic floor are important to understanding pelvic diseases. These diseases can be connected with a variety of risk factors, including hormonal changes, vaginal birth, and obesity, all of which have an impact on mechanical response. The PFM are the body's only transverse load-bearing muscle group, supporting the abdominal and pelvic organs. Dual role of supplying stability in the lumbopelvic area.

PFM diseases, such as urinary incontinence, non-obstructive urine retention, painful bladder syndrome, fecal incontinence, persistent constipation, and sexual dysfunction, pose a number of obstacles for treating physicians. PFM are also part of a much larger skeletal system known as the abdominal core, which works in tandem with the diaphragm, lower back, and abdominal wall muscles to influence spinal stability, spinal alignment, and respiration. The PFM links to several of the thigh muscles and is thus stimulated while walking, running, and performing various other dynamic movements. 

Keywords

 low back pain, female pelvic floor dysfunction, lumbopelvic stability

Introduction

The superficial and deep PFM provide a variety of roles in the musculoskeletal as well as other systems, including the urinary, gastrointestinal, sexual, and respiratory. They help to regulate intra abdominal pressure [1] and breathing [2], play a role in sacroiliac joint support [3], pelvic and lumbar spine equilibrium, act as a postural stabilizer to aid in core stability [2], contribute to sexual activity [4], and act as a support system for continence maintenance and prolapse of pelvic organs prevention [5,6]. PFM dysfunction has lately been linked to the onset of Low Back Pain (LBP). Research suggests a relationship between LBP and PFD.

PFM dysfunction can be classified as pelvic pain syndromes, voiding/defecatory problems (urinary incontinence, anal/FI, retention, urgency), constipation, POP, and sexual dysfunction. The PFM are the body's only transverse load-bearing muscle group, and they support the abdominal and pelvic organs. The dual purpose of providing stability in the lumbo-pelvic area. PFM has been postulated to help regulate the lumbar spine by contributing to intra-abdominal pressure (and consequently fascial tension) and pelvic stability via strengthening the sacroiliac joints [7]. PFD is an umbrella term that refers to a wide range of clinical problems, including bowel and bladder incontinence, pelvic organ prolapse, sexual dysfunction, and chronic pain syndromes involving the pelvic tissues and musculature [8-10] Figure 1, Figure 2.

Figure 1 & Figure 2. Pelvic floor muscles

Figure 3. Sacrum mobility with PFM

Kinesiology and muscle physiology research have shown that LBP can develop as a result of changes in control of the conventional trunk muscles (transversusabdominis, rectus abdominis, and multifidus); more recent research has recognized the role of the PFMin spinal stability [11,12].
Co-activation of the PFMs and abdominal muscles improves spinal stability by hardening the spinal column and raising intraabdominal pressure. It is probable that a lack of PFM activity affects the neuromuscular link between the PFMs and the abdominal muscles, resulting in a disruption in muscle synergy [13]. So, the goal of this review is to highlight the excessive link between LBP and PFD.

Literature Review

Low back pain and urine incontinence have been linked in major epidemiological studies, and having symptoms of one appears to predispose to the development of the other. There is insufficient data to show that pelvic floor therapies are beneficial for LBP in this patient population; thus, the mechanism underlying this link is still unknown [14].

During clinical practice, we have seen patients with temporally linked low back pain and urine symptoms; however, no relevant neurological disorders have been discovered during neurological consultation or spinal imaging. Sometimes it occurs as a result of an acute low back injury, while other times the urine and back pain symptoms develop gradually. Previous research has revealed a relationship between LBP and PFD [15,16].

Cadaveric investigations have shown that greater pelvic floor tension stabilizes the sacroiliac joint, aligns the sacrum, and enhances the lumbar spine and pelvis' ability to withstand physical stress [7].
Vleeming, et al. [17] illustrate how the pelvic girdle's ligaments, fascia, and muscles contribute to SI joint stability. Force closure, along with the intrinsic bony congruency of the SI joint surface, provides maximum SI joint stability. Pool-Goudzwaard, et al. [7] conducted a biomechanical investigation on 18 cadaveric specimens (9 males and 9 females) and found that simulated strain on pelvic floor muscles increased stiffness across the SI joints. The authors hypothesized that greater pelvic floor muscle activation may occur in individuals with SI joint dysfunction in an attempt to reestablish load transmission via the lumbopelvic region. It should be noted that the specimens were of an average age of 77 years (SD 14.4), and therefore, this biomechanical relationship may differ in younger patients. [7].

The levatorani muscle is a fiber-reinforced muscle of the skeleton located between the pubic bone at the front and the coccyx at the back [18]. To better understand the mechanical features of the PFM in various diseases, the first step is to correctly duplicate the female pelvic anatomy-the levatorani and surrounding tissues (coccyx, obturator muscles, and symphysis pubis [19]. The sacrococcygeal joint is formed when the sacrum's apex and the initial coccyx segment connect. There is a sacrococcygeal fibrocartilage disc, commonly known as the interosseus ligament. The sacrococcygeal joint has a normal range of 15° flexion and 13° extension. In normal physiological movement, when the sacrum extends the top of the coccyx moves anteriorly or flexes, and as the sacrum flexes, the top goes posteriorly or extends. The sacrum consists of five fused segments, while the coccyx is made up of five joined primitive bones. The interosseous, dorsal, and anterior sacroiliac ligaments all work together to keep the sacroiliac joints stable. Other auxiliary ligaments, such as the iliolumbar, stabilize the upper half of the joint, while the sacrospinous and sacrotuberous stabilize the lower part of the sacrum. The anococcygeal ligament, located at the distal end of the coccyx, connects the rectoanal angle, levatorani, and pelvic organs [20,21] Figure 3.

These diseases may result from changes in the mechanical characteristics of supporting structures caused by muscle or ligament damage or alterations in the elasticity of the pelvic fascia and bone associated with the previously mentioned risk factors [22]. Abnormalities in the pelvic ligaments and fascia may be related to reduce total collagen and elastin [23].

Large epidemiological studies have linked LBP with PFD, and having symptoms of one appears to promote the patient's development of the other.

The lumbopelvic-hip complex contributes to the formation of the core. The diaphragm, PFM and hip complex, abdominals, spine, and gluteal muscles are all included in the three-dimensional box or canister known as the core. Although there are multiple global (bigger, longer) and local (smaller, shorter) muscles involved in core stability [24,25], variations in core muscle activity during FSD utilizing non-invasive medical imaging may assist doctors better assess lumber angle and pelvic tilt[26,27]. PFM exercise is beneficial to sexual activity and quality of life [28].

Conclusion

Physiotherapy, including the pelvic floor rehabilitation, should be a helpful intervention when these conditions coexist. Women with PFD may have increased LBP. PFM strength and diaphragm excursion in females should be taken into consideration in LBP associated with PFD, which helps the therapist in therapeutic decisions and may be useful in developing guidelines for treating PFD.

Financial support and sponsorship

Nil.

Conflicts of Interest

No conflicts of interest are present.

Ethical Statement

Review.

Consent Statement

Nil.

Data Availability

Nil.

Permission to reproduce material from other sources statement

Give full citation of the work &acknowledge the original source correctly in your work.

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Editorial Information

Editor-in-Chief

Yoshiaki Kikuchi

Tokyo Metropolitan University

Article Type

Review Article

Publication history

Received date: April 08, 2024
Accepted date: May 22, 2024
Published date: May 24, 2024

Copyright

©2024 Abdel Hady DA. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Doaa A. Abdel Hady (2024) Updates in Low Back Pain and Female Pelvic Floor Dysfunction, Review Article. Physiother Res Rep 5: doi: 10.15761/PRR.1000135

Corresponding author

Dr. Doaa A

Dr. Doaa A. Abdel Hady, Department of Physical Therapy for Women's Health, Deraya University, Minia, Egypt

Figure 1 & Figure 2. Pelvic floor muscles

Figure 3. Sacrum mobility with PFM